Japan: Earthquakes, Tsunamis, and Suicide

With the Japanese nuclear crisis (which I write about in this week’s issue of the magazine) tentatively under control, Japan is racing to get mental-health workers in to see displaced and traumatized survivors. The prospect for post-traumatic problems is, of course, profound: the Timestells us today of a twelve-year-old boy who was swept by himself into the ocean for an hour before being recovered, naked and banged up; he remained in shock and unable to talk for days. Or, for that matter, the boy’s school principal, who said, “I want the surviving kids to shine—to continue their lives.” (The principal’s sister and brother have been missing since the tsunami, and her house is destroyed.)

Or consider the psychological effects on two thousand and five hundred “radiation refugees,” holed up in the Saitama Super Arena north of Tokyo, usually home to concerts and sports events. Among them is a sixty-three-year-old woman who survived the quake, survived the tsunami, only to look out her window and see the No. 1 nuclear reactor exploding and thought, “This is it.”

It is a grim but unavoidable question: Must Japan brace for a silent wave of suicides in the years ahead? Living in China, which is still reckoning with the mental-health effects of its own twentieth-century traumas, I wanted to know the likelihood for trouble ahead. But a look at the data on natural disasters and suicides provides surprising comfort. Because Japan already has one of the highest suicide rates in developed world—over thirty thousand per year for thirteen years in a row—the subject is a national issue, and researchers track the fluctuations with extraordinary precision: an increase last year in the number of child caretakers who killed themselves; a jump in the suicide rate of the unemployed.

Intuitively, suicide would seem to follow events of horrendous trauma, so it was not surprising in 1999 when The New England Journal of Medicinereported that victims of floods, earthquakes, and hurricanes had higher rates of suicide. But then the findings were retracted the next year, because of an error in the research; in fact, the study had found no increase in suicide rates. Studies of the 1995 earthquake in Kobe found that suicide rates actually fell after the quake compared to the ten years prior. A similar study of California’s Northridge earthquake of 1994 found that rates fell there as well. Researchers didn’t know why—perhaps regression to the mean, they suggested. They also concluded: “Suicides are fairly rare events, and single disasters rarely have covered geographic areas with populations large enough to find statistically significant differences in such relatively rare events.” Likewise, after the 2004 tsunami in the Indian Ocean, researchers in Sri Lanka found “no significant differences” in rates before and after. (Among their theories for why, they offered a bleak hypothesis: that “in the context of a country with one of the highest suicide rates in the world and an ongoing civil war in certain regions, the tsunami disaster failed to have any profound effect on societal forces affecting suicide….”)

That’s not encouraging, but there is a potentially positive takeaway: in a country like Japan, which was already focussed on trying to reduce suicide—and the stigma and social forces that surround it—recognizing the threat beforehand could be vital in preventing an increase. In an early assessment of Japan’s health needs after the quake, the British medical journal Lancetwrote yesterday, early attention to mental health will be vital, especially for children. (A hundred thousand are estimated to be displaced right now.) “Children who have been caught up in disasters can develop behavioural and mental health problems unless they receive counselling at an early stage,” Lancet warned. “Left untreated, those initial fears can impinge on their development as adults….”